Trend toward earlier treatment of uveal melanoma observed

Issue: November 25, 2014

CHICAGO — Despite identification of risk factors, many ophthalmologists still observe borderline lesions, waiting for growth before initiating treatment of uveal melanomas, Jerry A. Shields, MD, said in his delivery of the Charles L. Schepens, MD, Lecture here.

That trend, however, is not reflected in how cancers in other specialties are managed.

“If you look at cancer management in other specialties, early diagnosis and prompt treatment is responsible for improved prognosis,” Shields said during the Retina Subspecialty Day preceding the American Academy of Ophthalmology meeting.

Jerry A. Shields

For example, precancerous polyps are removed as a measure to prevent colon cancer, he said.

Shields cited cutaneous melanoma, a “cousin” of uveal melanoma, as another example.

“It has been shown that thickness is the most important prognostic factor,” he said. “Melanomas less than 0.7 mm in thickness have a 100% 10-year survival if treated at that time.”

For posterior uveal melanoma, the prognosis remains poor, even though diagnosis can be made sooner with newer detection modalities and the availability of excellent local treatments, according to Shields.

Even so, he did not recommend prophylactic treatment of all choroidal nevi.

“Before you jump to conclusions, there are even stronger arguments against treating all choroidal nevi,” he said.

Choroidal nevi occur in 5% of the population, but melanoma is uncommon; many treatments would be unnecessary, most nevi have an excellent prognosis and stay with the patient for a lifetime, growth and metastasis are rare, and treatment causes visual loss, according to Shields.

“We cannot and we should not treat all choroidal nevi, but there has been a trend toward earlier treatment in recent years based on the risk factors that have been identified and used in most centers,” he said.

Disclosure: Shields has no relevant financial disclosures.